This preprint article presents a meta-analysis of population-based seroprevalence studies conducted in Africa published 01-01-2020 to 30-12-2021 to estimate SARS-CoV-2 seroprevalence in Africa. The authors aim to inform evidence-based decision making on Public Health and Social Measures (PHSM) and vaccine strategy. From 54 full texts or early results, reporting 151 distinct seroprevalence studies in Africa, 63% had a low/moderate risk of bias. SARS-CoV-2 seroprevalence rose from 3% in Q2 2020 to 65% in Q3 2021. The ratios of seroprevalence from infection to cumulative incidence of confirmed cases was large (overall: 97:1, ranging from 10:1 to 958:1) and steady over time. Seroprevalence was highly heterogeneous both within countries - urban vs. rural (lower seroprevalence for rural geographic areas), children vs. adults (children aged 0-9 years had the lowest seroprevalence) - and between countries and African sub-regions (Middle, Western and Eastern Africa associated with higher seroprevalence).The high seroprevalence in Africa suggests greater population exposure to SARS-CoV-2 and protection against COVID-19 disease than indicated by surveillance data.
Equity in Health
The 10 recommendations in the COP26 Special Report on Climate Change and Health propose a set of priority actions from the global health community to governments and policy makers, calling on them to act with urgency on the current climate and health crises. The recommendations were developed in consultation with over 150 organizations and 400 experts and health professionals. They were intended to inform governments and other stakeholders ahead of the 26th Conference of the Parties (COP26) of the United Nations Framework Convention on Climate Change (UNFCCC) and to highlight various opportunities for governments to prioritize health and equity in the international climate movement and sustainable development agenda. Each recommendation comes with a selection of resources and case studies to help inspire and guide policymakers and practitioners in implementing the suggested solutions.
The authors present how COVID-19 has exposed, exploited and exacerbated the health-damaging transformations of neoliberal globalization. To explain why, the authors point to a combinatory cascade of socio-viral co-pathogenesis that they call neoliberal disease. From the vectors of vulnerability created by unequal and unstable market societies, to the reduced response capacities of market states and health systems, to the constrained ability of official global health security agencies and regulations to offer effective global health governance, they authors show how the virus has found weaknesses in a market-transformed global body politic. Turning the inequalities and inadequacies of neoliberal societies and states into global health insecurities, the pandemic raises questions about whether the world now faces an inflection point when political dis-ease with neoliberal norms will lead to new kinds of post-neoliberal policy-making. The authors conclude, however, that the prospects for such political-economic transformation on a global scale remain quite limited. despite the evidence of the extraordinary damage described.
Although household habitat conditions matter for disease transmission and control, especially in the case of COVID-19, inadequate attention is being given to these risk factors, especially in Africa, where household living conditions are largely suboptimal. This study assesses household sanitation and isolation capacities to understand the COVID-19 transmission risk at household level across Africa, using a secondary analysis of the Demographic and Health Surveys of 16 African countries implemented between 2015 and 2018, exploring handwashing and self-isolation capacities and households with elderly persons most at risk of the disease. Handwashing capacity was highest in Tanzania (48%), and lowest in Chad (4%), varying by household location (urban or rural), as well as household wealth. Isolation capacity was highest in South Africa (77%), and lowest in Ethiopia (31%). Senegal had the largest proportion of households with an elderly person (42%), while Angola (16%) had the lowest. There were strong, independent relationships between handwashing and isolation capacities in a majority of countries. Also, strong associations were found between isolation capacity and presence of older persons in households. Household capacity for COVID-19 prevention varied significantly across countries, with those having elderly household members not necessarily having the best handwashing or isolation capacity. The authors propose from the findings that each country needs to use such information on household risk at population level to shape communication and intervention strategies.
Africa is estimated to have seven times more COVID-19 cases and three times as many deaths as officially reported, according to the World Health Organization (WHO) Africa region. This means that the continent could have around 59 million cases and 634,500 deaths. “We’re using a model to estimate the degree of under-estimation. The analysis indicates that as few as one in seven cases is being detected, meaning that the true COVID-19 burden in Africa could be around 59 million people,” said Dr Matshidiso Moeti, WHO’s Africa executive director. WHO recommends that countries perform 10 tests per 10,000 people each week yet around 20 countries – more than a third of African countries – do not reach this benchmark, said Moeti. The WHO has thus decided to invest $1.8 million to roll out COVID-19 rapid tests in hot spots, starting with pilots in eight countries. Despite this undercount, WHO Africa officials observe lower deaths in Africa than other global regions.
This series of 10 images tell the story behind the ‘great vaccine apartheid’ argued by the author to be the single biggest moral and scientific failure during this the COVID-19 pandemic.
The concept of health security has long been prominent and controversial in global efforts to protect health. The author asserts that paradoxically, the COVID-19 pandemic has provided evidence of this concept's failure and reignited interest in it for the post-pandemic world. The article outlines how past shortcomings and present interest highlight the continued failure to address political and economic structural problems that generate inequities and produce neither health nor security for most of the world’s population. Thinking beyond the pandemic, she proposes that policymakers should reject health security and center policy on promoting human solidarity and protecting the human right to life.
This assessment identified risk factors, mental health, psychosocial needs and mechanisms of coping by children under the care of female sex workers (FSWs) and adolescent girls surviving in sex work settings of Kampala, Gulu, Mbarara, Wakiso and Busia in Uganda. The study found stigma and discrimination, poor accommodation facilities, sexual abuse by clients of sex workers and substance abuse among children, adolescent girls and mothers, gender-based violence and low levels of literacy, with a high prevalence of mental health disorders, including depression, suicide, post traumatic stress symptoms and generalised anxiety disorder. Adolescent girls surviving in sex work settings, presented higher rates of common mental health disorders. particularly those aged 11-14 years. The study found that the risk factors are not addressed given that children under the care of FSWs and adolescent girls are often neglected by systems.
Equity and universality are implicit in universal health coverage (UHC), although ambiguity has led to differing interpretations and policy emphases that limit their achievement. Diverse country experiences indicate a policy focus on differences in service availability and costs of care, and neoliberal policies that have focused UHC on segmented financing and disease-focused benefit packages, ignoring evidence on financing, service, rights-based and social features that enable equity, continuity of care and improved population health. Public policies that do not confront these neoliberal pressures limit equity-promoting features in UHC. In raising the impetus for UHC and widening public awareness of the need for public health systems, COVID-19 presents an opportunity for challenging market driven approaches to UHC, but also a need to make clear the features that are essential for ensuring equity in the progression towards universal health systems.
The new Global AIDS Strategy (2021–2026) uses an inequalities lens to identify, reduce and end inequalities that represent barriers to people living with and affected by HIV, countries and communities from ending AIDS. The Strategy outlines a comprehensive framework for transformative actions to confront these inequalities and to respect, protect human rights in the HIV response. It puts people at the centre to ensure that they benefit from optimal standards in service planning and delivery, to remove social and structural barriers that prevent people from accessing HIV services, to empower communities to lead the way, to strengthen and adapt systems so they work for the people who are most acutely affected by inequalities, and to fully mobilize the resources needed to end AIDS.